Medicaid expansion up for debate

By: Senate President Debby Barrett

Over the past 65 days, there have been numerous proposals presented to the legislature that can aptly be described as “take-it-or-leave-it”.  The CSKT Water Compact, the Governor’s infrastructure proposal, HB 5, the Governor’s proposal to expand Medicaid, HB 249, and the Governor’s state pay-plan, HB 13 are all examples of policies that the legislature was expected to rubber stamp, without any changes.  But one proposal tops all others when it comes to the audacity of a “take-it-or-leave-it” offer—Senate Bill 405.

Just a few short weeks ago, a new concept for Medicaid expansion was brought before the legislature that some claim is a “collaborative effort” exemplifying statesmanship. The bill, SB 405, has been lauded as a “compromise” that will benefit tens of thousands of Montanans if enacted.  But while policymakers get caught up in the emotional cloud that dominates the debate surrounding Medicaid expansion, it’s important to keep things in perspective—particularly the long-term sustainability of any plan that the legislature chooses to adopt.

First, it’s important to recognize that SB 405 is not a compromise. When numerous amendments were offered to improve the proposal, the sponsor, after acknowledging that the amendments were good, asked the Senate to reject each and every one of them.  Does that sound like “compromise” to you? Does that sound like a “Montana Solution” to you?

Second, regardless of the proponent’s claim that SB 405 is a “Republican solution”, it is the implementation of Obamacare, plain and simple—something few Montanans are eager to support.  SB 405 accepts hundreds of millions of dollars in federal funds offered through the Affordable Care Act to create a new entitlement program.  And, in addition to spending hundreds of millions of dollars to expand entitlements, SB 405 also creates a massive new state bureaucracy that will cost the state millions of dollars every year in administrative costs alone.  Simply put, SB 405 is uniquely this country’s most enhanced Medicaid expansion proposal yet.  But, can we really rely on federal money to be there to pay for it?

The federal funds that cover a portion of the costs of Medicaid expansion have proven to be laden with restrictions.  We already know that these particular funds will be reduced after the first few years, and the program is expected to cost the state of Montana almost $40 million by the year 2020, with that number increasing exponentially every year after the federal funds go away.  After considering this phenomenal cost, is it really that hard to understand why so many lawmakers are hesitant to support Medicaid expansion?

Proponents of full Medicaid expansion vilify the legislators who want to ensure prudent management of the program by falsely claiming these legislators are “attacking the poor” because they choose not to vote in favor of blindly throwing money at the problem.  Even though many members of the legislature will not vote for full expansion of Medicaid, it’s important to remember that real Republican alternatives are currently still in play in the last weeks of Montana’s 64th legislative session.

HB 455, introduced by Rep. Nancy Ballance, would cover nearly 10,000 low-income Montanans currently unable to receive coverage under Medicaid. That bill would expand coverage eligibility to the blind, disabled, young parents and veterans.  Unfortunately, those legislators rushing to get their hands on the federal dollars cannot see the benefit of a proposal that targets public resources to help the most vulnerable in our communities.

We must be cautious when formulating our public policies.  Creating a massive program that throws money at the problem is not responsible policymaking, and will almost certainly put our state’s financial health in jeopardy.  SB 405 is not an example of a Republican solution, and to claim otherwise is insulting.  It’s time that proponents of full Medicaid expansion drop their “take-it-or-leave-it” mentality and consider for the first time a true compromise—because that is the only way we can ensure protection of Montana’s most vulnerable without jeopardizing our state’s financial health.

Senator Debby Barrett, R-Dillon, is an eight-term lawmaker representing Senate District 36 in the Montana Legislature.  She serves as Senate President for the 64th legislative session